Respiratory failure among emergency department (ED) patients is common, deadly, and expensive. In the United States, almost 400,000 patients per year undergo mechanical ventilation in the ED [1,2], and their in-hospital mortality exceeds 25 % [1,2]. Mechanically ventilated patients treated in the ED accrue millions of hospital days annually and are at risk of serious long-term cognitive and psychological morbidity [[3], [4], [5], [6], [7]].

The provision of sedation and analgesia is a critical component of care for patients undergoing mechanical ventilation [8]. Appropriate sedation ameliorates pain and distress related to mechanical ventilation and underlying medical conditions, and facilitates critical care interventions. Abundant evidence from the intensive care unit (ICU) setting demonstrates that in most patients, light sedation is associated with better outcomes than deep sedation, including lower incidence of delirium, shorter duration of mechanical ventilation, and lower mortality [[9], [10], [11]]. Preliminary evidence suggests that this is also true in the ED setting [[12], [13], [14], [15]].

Post-intubation sedation in the ED is understudied. Over the past decade, hospital and ED overcrowding leading to “boarding” of critically ill patients in the ED while awaiting ICU beds has significantly increased [[16], [17], [18], [19]]. The National Academy of Medicine has identified ED crowding and boarding as a critical healthcare delivery problem, particularly for critically ill patients awaiting ICU placement [20]. There is increasing recognition that post-intubation sedation is a critical ED intervention that could have a significant impact on downstream care and patient outcomes [[12], [13], [14], [15]].

The scientific literature on post-intubation sedation in the ED has not, to our knowledge, been systematically characterized, summarized, or critiqued. A comprehensive investigation of this literature is necessary to: determine the scope of existing knowledge, identify gaps in methodology and outcome reporting, and generate guidance for future clinical research. We therefore conducted a scoping review of post-intubation sedation in the ED to collate the literature on the topic and characterize the methods and scope of the published evidence.